https://www.youtube.com/watch?v=cQR67WRcVUg&t=7
Americans Hate Their Private Health Insurance
The response to UnitedHealthcare CEO’s murder surely disproves the claim that Americans love the private health insurance system. It’s a political force waiting to be harnessed — but few in DC seem interested.
Americans are not happy with the US health care system. For the first time in two decades, a majority of Americans rate US health care as substandard, including a new high calling it “poor.” Nearly three-quarters say it’s failing to meet their needs, and about half find it difficult to afford their medical bills. A majority have had some kind of problem — denied claims, for instance, or issues with provider networks or pre-authorization — with their insurance, and even bigger majorities feel insurers aren’t transparent about what they cover, or think insurance bills or the various payments they have to make to insurers are not easy to understand.
But forget the polls. If you want to get a sense of just how deep and widespread Americans’ rage at this often absurd and unfair system is, just look at the public reaction to the shocking news of the assassination of Brian Thompson, the CEO of UnitedHealthcare (UHC), one of the country’s most cruel and rapacious health insurance companies. Whatever his killer’s motive, across the internet — on social media, YouTube, news comments sections, and more — the response has been the same: Americans are either gleefully mocking his death, saying they understand why it happened even if they don’t condone it, or sharing their own appalling personal experiences with health insurers.
The fact that this is the US public response, en masse, to the murder of a human being speaks volumes about Americans’ widespread disgust with a profit-driven health care system that leaves so many destitute or simply dead.
“I Hate Insurance Companies”
A Facebook post by the company expressing sadness and shock at Thompson’s killing has, as of the time of writing, nearly eighty thousand laughing emoji reactions. Twitter/X exploded with jokes about his murder.
“A good lesson here is that you should live your life in such a way that when you die, nobody pulls out a spreadsheet to mathematically explain why they’re happy you’re dead,” wrote comedian Kristin Chirico in a tweet that so far has 54,000 likes.
“Chipotle raised its prices again and someone just asked who the CEO is LMFAOOOO,” another user tweeted, garnering 315,000 likes so far.
Many of these are being collected and cross-posted on Instagram. Angry commentary is also happening at X’s rival, Bluesky. “The reward out for the person who shot United Healthcare’s CEO isn’t even enough to cover 1/9 of the bill we got for 28 days of radiation,” cartoonist Marie Enger wrote on the platform, receiving thousands of likes.
TikTokers are writing and performing songs celebrating Thompson’s murder, with lyrics like “the people got a prize in a blood celebration” and “you should never have to face the things your customers all face,” directed at CEOs. Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It — a fourteen-year-old book criticizing health insurance companies’ practices whose title closely matches the words written on the casings of the bullets Thompson’s killer fired at him — has suddenly rocketed to number three on Amazon’s best-selling books in the business and money category.
On Reddit, a thread about the murder on the r/medicine subreddit — a forum that describes itself as “a virtual lounge for physicians and other medical professionals” — had to be closed by moderators because users responded with a spree of jokes. The top comment is from a nurse who wrote out a parody of a UHC denial-of-care letter, in this case addressed to Thompson regarding his emergency treatment after being shot. UHC couldn’t cover his emergency services, explains the comment, because he hadn’t proved “medical necessity,” he hadn’t gotten “prior authorization,” the ER he went to was out of network, and he hadn’t explored other, lower-cost options.
“We understand that you were actively ‘bleeding out,’ but this does not exempt you from exploring lower-cost care pathways,” says the comment.
It was a similar scene over at r/nursing, another forum run and populated by medical professionals, specifically nurses. That subreddit is now filled with “Code Blue Threads” — meaning threads that moderators had to restrict comments on — making snarky responses to Thompson’s murder and to health insurance executives fretting for their security or backtracking on some truly heinous policy changes in response. A moderator had to post a reminder that content advocating for violence was not allowed and would be removed. (“I don’t envy your position in the slightest. It’s like having to be the one to stop the people from playing soccer with Mussolini’s head,” replied one user.)
One of that subreddit’s threads about the murder made it over to r/SubredditDrama, a forum covering what are considered particularly entertaining internal controversies in the site’s various subreddits. A user posted “some highlights” of the snarky comments in the thread, like a discussion about good tuna salad recipes, or one charging that a “bullet in chest . . . sounds like a pre-existing condition” and that Thompson should “try physical therapy” instead. The poster notes that a comment chiding people that “celebrating a murder and calling for more is gross” was downvoted way into the negatives — meaning disapproval by users en masse.
Similar or even more scathing comments were rife throughout the r/nursing subreddit: “I hope they bill his family for the ambulance ride in this trying time”; “No sympathy here, and his millions of dollars are now worthless to him”; “Sounds like this is related to the pre-existing condition of being an amoral asshole.” “The absolute savagery in these comments really shows you how absolutely sick we all are of our patients and families being fucked by insurance companies,” wrote another user. The r/jokes subreddit is packed with jokes about the murder, which are currently some of the most upvoted threads on the page (meaning they’ve gotten the most approval from users of the forum).
Meanwhile, several users took the occasion to relate their own horror stories of working with insurers, including UHC.
“I work at a gastroenterology center in billing, and I have actually had to argue with UHC because they didn’t want to deem a procedure for a man who had been shot in the stomach as ‘emergent,’” wrote one account whose comment was met with numerous replies from users sharing their own stories. “I hate insurance companies. Insurance is a literal scam.”
Another user recounted how he suspected that UHC had made a deal with his former employer, AT&T, to exclude his jaw surgery from coverage, because his surgeon had had at least thirteen patients with the company that year and seen similar denials. Despite being told he “would lose the ability to chew by [his] forties,” he couldn’t get the surgery, and now, at forty-two, he can only eat certain foods while in extreme pain and is worried about the possible side effects of retrying the procedure at an older age. “So, I won’t outright say how I feel but you might guess it,” he concluded.
This was not unique to Reddit. You could find the same sentiment on YouTube, in the comments sections of videos about the murder from CNN (“oh my god that’s so horrible!! is the floor that he fell on okay???”), Inside Edition (“I’m sorry but empathy is out of network”), and the Today Show (“UHC has destroyed many lives and families. Condolences: denied”; “If you have any information on the shooter, keep it to yourself”), for instance. When CBS Mornings posted a video yesterday covering this outpouring of popular anger, YouTube commenters heaped scorn on the anchors.
“How can she say with a straight face, ‘we’re a country of law & order’? Since when have any of these corrupt, greedy corporations been held accountable?” was the most-liked comment.
“You should have called this video ‘Out of touch, rich [news] anchors shocked by common people’s anger over watching their families die due to denied claims,’” went the second-most liked.
You’re seeing the same kind of thing in the comments sections of right-leaning news outlets. One of the Wall Street Journal’s stories on the matter has more than two thousand comments, far more than most of its other stories. “After just watching Pain Hustlers on Netflix, I can understand how this incident could happen. . . . Don’t condone it, but understand,” wrote one reader. “Oh well. What’s for lunch?” wrote another.
This was repeated in stories about the killing on Fox News (“I’ve been a surgeon for almost a decade and I see patients suffer daily because insurance companies put profits over healthCARE every time — something that I find morally abhorrent”), the Daily Mail (“I work in healthcare and UHC is one of the worst insurances we work with. They deny EVERYTHING initially and it is outrageous the hoops we have to jump through to provide patients with this insurance.”), and even the New York Post (“United Health Care mailed me some messages too: Denied, Declined, Deductible, Out of Network, Pre-Approval Needed, Co-payment, Your Monthly Premium has increased. That translates to a lot of ammo.”) — despite the paper taking a disapproving editorial stance toward the less-than-sympathetic responses to the crime.
Good Morals and Good Politics
What is particularly stunning about all this is that one of the core arguments used against putting in place a single-payer health care system like Medicare for All in the United States — by politicians, political commentators, corporate flacks — is that people simply love their private health insurance too much. These comments show this is blatantly untrue.
In fact, they show that public hatred of the predatory US private insurance system runs through not just patients but health care professionals ranging from nurses to surgeons and even workers responsible for billing at health care providers. And more importantly, that hatred isn’t limited to the left side of the political spectrum.
Yet when Bernie Sanders ran for president in 2020 calling for Medicare for All, Americans’ supposed love for their insurance was constantly thrown at him as an argument against his proposal.
“I’m not going to support any plan that rips away quality health care from individuals,” then Montana governor Steve Bullock said in a debate, describing something that already happens under private insurance.
“The real obstacle to Sanders’s plan is the public’s expectations,” went one Atlantic op-ed. “As much as Americans hate insurance companies in general, they want the right to have a love-hate relationship with their own insurer.”
Sanders’s lonely stance, promising that he would almost entirely abolish private insurance, was framed by pundits as so politically risky that multiple of his Democratic rivals ran away from it. That included the next-most progressive candidate in the race, Elizabeth Warren.
The other candidate who did so was Vice President Kamala Harris. This was one of the supposedly unpopular left-wing stances from her 2019 campaign that we were told Harris had to overcome to beat Donald Trump for president this year, as she came under right-wing attack for the position and, true to form, wilted under the pressure, selling her flip-flopping as an act of sensible, moderate political maturity.
The deluge of public wrath toward insurers in the wake of this startling crime — let alone the possible health care–related motive of the killer — casts serious doubt on this piece of conventional political wisdom. In fact, it calls into question the political establishment’s entire thinking on health care.
For Republicans, that means making no changes to health care whatsoever, other than making it easier for companies like UHC to deny claims and screw over patients, making it harder for people to sue insurance companies, and making Americans more reliant on them by crippling public health care programs with spending cuts. For Democrats, that means leaving the status quo in place and modestly expanding Medicare while making only vague promises to “strengthen the Affordable Care Act” (ACA) — even though the intolerable status quo that internet users are eviscerating right now is a direct result of nearly fifteen years under the ACA.
If you’re a Democratic official, you must surely be kicking yourself for the direction the party has taken on this issue. First, there was Joe Biden’s decision to abandon the public health insurance option pledge he made on the campaign trail upon winning — and that was before he signed legislation that led to more than 25 million people being thrown off their Medicaid insurance since last year, including millions who were still eligible but lost it for procedural, bureaucratic reasons.
Second, there was the decision of Harris and her team to offer no substantive health care reform to anyone under sixty-five (that is, anyone who isn’t eligible for Medicare). One of the indelible moments on the road to Harris’s election failure came in an October Univision town hall, when a sixty-two-year-old disabled woman who had become homeless due to a series of ailments asked the vice president how she would “make America great again” by helping disabled people like her get health insurance once more. Harris, who had no policy to offer, replied with a lengthy word salad before simply suggesting that she’d ensure the homeless woman’s medical debt wouldn’t count against her credit score.
Anger at the privatized US health care system is not just a matter of moral urgency (for the ordinary people who suffer constantly under that system as well as the executives who get death threats from them). It’s clearly a potent political force waiting to be harnessed. No one in Washington seems to have much interest in doing so right now. If and when they do, it could cause a political earthquake.
https://jacobin.com/2024/12/unitedhealthcare-murder-private-insurance-democrats
Fwd: Fw: A Manifesto Against For-Profit Health Insurance Companies — by Michael Moore
It’s been three days since Luigi Mangione’s manifesto was discovered in his backpack explaining why he assassinated the CEO of United HealthCare.
In Mangione’s manifesto, he said that he was not the “most qualified person to lay out the full argument” against our for-profit healthcare industry. Apparently, to Mangione, one of those qualified people — is me. In his manifesto, he references how I’ve “illuminated the corruption and greed,” implying folks should go to my work to understand the complexity — and the power-hungry abuse — within our current system.
It’s not often that my work gets a killer five-star review from an actual killer. And thus, my phone has been ringing off the hook which is bad news because my phone doesn’t have a hook. Emails are pouring in. Text messages. Requests from many in the media. The messages all sound something like this:
“Luigi mentioned you in his manifesto. That people should listen to you. Will you come on our show, or talk to our reporter and tell them that you condemn murder!?”
Hmmm. Do I condemn murder? That’s an odd question. In Fahrenheit 9/11, I condemned the murder of hundreds of thousands of innocent Iraqi people and the senseless murder of our own American soldiers at the hands of our American government.
In Bowling for Columbine, I condemned the murder of 50,000 Americans every year at the hands of our gun industry and our politicians who do nothing to stop it.
In my 35 years as a filmmaker, have I said or done anything that has implied I condone murder? As a teenager during the Vietnam War, I was required to register for the draft at the local draft board. There was a box on the form asking me if I had a problem with killing Vietnamese people. Actually, it just asked me to check the box if I was going to file for Conscientious Objector status — meaning, if given the opportunity, would I swear that I would never kill a Vietnamese person. I checked the box. Throughout my adult life, I have repeatedly stated that I’m a pacifist. In fact, I have never struck another human in my life. Not even on the playground. I was taller and bigger than the other boys so they mostly left me alone. Usually I was the one who would try to stop the bullies from picking on the smaller kids. When they’d start swinging at me, I would wrap my arms around them, pinning their arms to their sides in my “human straitjacket” and not letting them go until they stopped.
Here’s a sad statistic for you: In the United States, we have a whopping 1.4 million people employed with the job of DENYING HEALTH CARE, vs only 1 million doctors in the entire country! That’s all you need to know about America. We pay more people to deny care than to give it. 1 million doctors to give care, 1.4 million brutes in cubicles doing their best to stop doctors from giving that care. If the purpose of “health care” is to keep people alive, then what is the purpose of DENYING PEOPLE HEALTH CARE? Other than to kill them? I definitely condemn that kind of murder. And in fact, I already did. In 2007, I made a film – SICKO – about America’s bloodthirsty, profit-driven and murderous health insurance system. It was nominated for an Oscar. It’s the second-largest grossing film of my career (after Fahrenheit 9/11). And over the past 15 years, millions upon millions of people have watched it including, apparently, Luigi Mangione.
After the killing of the CEO of United HealthCare, the largest of these billion dollar insurance companies, there was an immediate OUTPOURING of anger toward the health insurance industry. Some people have stepped forward to condemn this anger.
I am not one of them.
The anger is 1000% justified. It is long overdue for the media to cover it. It is not new. It has been boiling. And I’m not going to tamp it down or ask people to shut up. I want to pour gasoline on that anger.
Because this anger is not about the killing of a CEO. If everyone who was angry was ready to kill the CEOs, the CEOs would already be dead. That is not what this reaction is about. It is about the mass death and misery — the physical pain, the mental abuse, the medical debt, the bankruptcies in the face of denied claims and denied care and bottomless deductibles on top of ballooning premiums — that this “health care” industry has levied against the American people for decades. With no one standing in their way! Just a government — two broken parties — enabling this INDUSTRY’s theft and, yes, murder.
And now the press is calling me to ask, “Why are people angry, Mike? Do you condemn murder, Mike?”
Yes, I condemn murder, and that’s why I condemn America’s broken, vile, rapacious, bloodthirsty, unethical, immoral health care industry and I condemn every one of the CEOs who are in charge of it and I condemn every politician who takes their money and keeps this system going instead of tearing it up, ripping it apart, and throwing it all away. We need to replace this system with something sane, something caring and loving — something that keeps people alive.
This is a moment where we can create that change.
But instead, what are we doing? What are our “leaders” doing? What is the Democratic Party doing?
This is what they are doing — THIS is why people are angry. Listen to an everyday American on TikTok:
And here is a perfect example of what the young man in that video is talking about — at a press conference this week, Pennsylvania Governor Josh Shapiro repeatedly grabbed the spotlight to say… this:
Shapiro wasn’t alone. After last week’s killing — which was just one more gun death in an unending sea of American gun deaths — our Democratic leaders all chimed in to say, “In America, we don’t solve our problems and our ideological disputes with violence!” and that there’s “no place for political violence” in America.
No place for political violence? America’s entire history is defined by political violence. We slaughtered the Native people who already lived here. We enslaved and slaughtered the African people our Founding Fathers kidnapped and brought here. We — to this day — force Women in our country to give birth against their will. 77 MILLION AMERICANS just voted in November to approve Trump mobilizing the U.S. Military to round up and forcibly remove immigrants, dead or alive, from our country. We spent $8 TRILLION in the last 20 years bombing and slaughtering people in the Middle East. We are spending billions and billions of dollars right now to bomb and kill and starve and exterminate women and children in Gaza… and you, our leaders, are telling us there’s no place for political violence in America?
People across America are not celebrating the brutal murder of a father of two kids from Minnesota. They are screaming for help, they are telling you what’s wrong, they are saying that this system is not just and it is not right and it cannot continue. They want retribution. They want justice. They want health care. And they want to use their money to live — not to throw it away each month into a black hole of health insurance premiums only to discover that when the time finally comes to use their insurance, when the leg breaks or the car crashes or the gun accidentally goes off, their health insurance company is there not to help them but to deny their claim, bankrupt them with deductibles and copays, and give them the runaround until their spirit is broken and they just give up and wait to die.
But the politicians and the pundits and the headlines aren’t telling you that. Just like they aren’t telling you the truth about this crime. They’re so busy telling you not to riot and not to participate in an uprising against their advertisers and campaign funders that they won’t tell you what this really is — a RICH ON RICH crime! Luigi, a young rich man with a couple of Ivy League degrees, scion of a family that owns 2 of the biggest country clubs in Maryland and who is in line to inherit a chain of nursing homes — in other words, scion of a family that’s enriched themselves off a broken healthcare system by bilking retirees and their families in their end-of-days — this young, rich man with an ax to grind against another multi-millionaire, a CEO facing a Justice Department anti-trust investigation, as well as accusations of bilking tax payers in Medicaid/Medicare schemes and of participating in illegal insider trading.
On Monday, the mainstream media was breathlessly reporting about Luigi’s “manifesto.” On Tuesday, though the manifesto was leaked, the mainstream media refused to publish it. By Wednesday, with the whiff of a perfectly choreographed PR move, the mainstream media stopped calling it a “manifesto” — now it was “a letter” or “a confession” or “rantings.” Some of the words were “indecipherable”! It wasn’t a “manifesto,” it was “nonsense”! Clearly the health insurance companies were immediately spending millions of dollars on publicists and lobbyists to convince each of the networks to send out a memo to their anchors and reporters banning the word “manifesto” in the desperate hope that the American public would not be inspired to rise up, not with violence, but with the immense power they already hold in their own hands. Because the numbers don’t lie. There are only 800 billionaires in this country, 6 million millionaires and 160 million of you reading this right now who are living from paycheck to paycheck and literally cannot afford the rent. For God’s sake, don’t call what he wrote a “manifesto” because the one mistake the rich have made is that those 160 million working class people were taught, free of charge, to read.
I don’t know.
When Lyndon Johnson used the manufactured Gulf of Tonkin incident to launch the Vietnam War, his address to the nation was 546 words long. LBJ’s manifesto ended with the pledge that America’s “mission is peace.” That mission ended in the pointless deaths of 58,220 American soldiers and 4 million people in Southeast Asia.
When George W. Bush addressed the nation on the night of his “shock and awe,” his manifesto was 578 words. In it, he promised that “The people [we] liberate will witness the honorable and decent spirit of the American military.” George’s words killed nearly 5,000 American servicemembers and countless thousands of Iraqis.
One hundred and sixty-three years ago, half our country, desperate to keep enslaving people, launched the Civil War, leading to President Abraham Lincoln’s manifesto — the Gettysburg Address… which is just 262 words long.
Luigi Mangione’s manifesto? It’s also 262 words long.
But don’t get me wrong. No one needs to die. In fact, that’s my point. No one needs to die – No one should die because they don’t “have” health insurance. Not one single person should die because their “health insurance” denies their health care in order to make a buck or Thirty Two Billion Bucks.
These insurance corporations and their executives have more blood on their hands than a thousand 9/11 terrorists. And that’s why they are scrubbing their executives’ profiles from their websites and putting up fences around their headquarters. Because they know what they have done. You can’t be the CEO of a company where you knowingly deny care to people — often leading to their deaths — and not have people mad at you, people hate you, people who have no pity for you because you have no pity for them.
But I have a solution. No one has to kill anyone. And it doesn’t cost anything. I have a solution that does not involve any violence. Unless violence to you means us taking money out of your rich effing pockets, unless violence to you means you can’t send your kids to USC or UPenn or buy a third vacation home or a fourth Tesla or a fifth Land Rover or another yacht.
The solution is simple. Throw this entire system in the trash, dismantle this immoral business that profits off the lives of human beings and monetizes our deaths, that murders us or leaves us to die, destroy it all, and instead, in its place, give us all the same health care that every other civilized country on Earth has:
Universal, free, compassionate, and full of life.
Give us Scotland. Give us Uruguay. Give us Taiwan. Give us Canada or give us death! Just go ahead and deny us all now the care that we will someday need. Or give us Canada and let us get busy curling.
And now, what I would like is for everyone reading this to watch my movie, SICKO, and then, when it’s over, join me in condemning this murderous health insurance system. Here it is… YOU can watch it right here, right now, for FREE (and please, please share this with your friends and family):
https://groups.google.com/g/onepayerstates/c/IaBYYGOttlk
Most Americans Say They Have Good Health Insurance, Polls Show
Many have encountered problems with their coverage, but the recent rage on social media is only part of the picture of Americans’ views on health care.
by Kaleigh Rogers - NYT - December 13, 2024
Americans voted last month in an election that polls showed was largely about the economy. Less than 1 percent of likely voters ranked health care as their top issue.
Now, health care, and in particular the health insurance industry, is suddenly a big topic of debate. After the killing of UnitedHealthcare’s chief executive, Brian Thompson, social media posts that cast him as a villain or expressed support for the gunman signaled to some a strong sense of dissatisfaction with the U.S. health insurance system.
Public polls, which can provide a broader sample of Americans’ views than the echo chambers of social media, also show that many people have experienced problems with their insurance coverage. But they also suggest that Americans’ overall opinions on the industry are nuanced, particularly because most people with health insurance rate their own insurance positively.
A Gallup poll released earlier this month found just 28 percent of Americans say health care coverage in the U.S. is excellent or good, the lowest figure the polling firm has found on that question since it started asking it in 2001. Yet 65 percent of Americans say their personal health care coverage is good or excellent, a contradiction that Megan Brenan, a senior editor at Gallup, said is not unusual in polling.
“We can’t answer ‘why’ from our data, but this is a phenomenon that we see across subjects,” Ms. Brenan said in an email. “Americans often rate their own personal situation better than the nation’s. For instance, we see it in ratings of Congress versus their own member of Congress, education in the U.S. versus their child’s education, and crime in the U.S. versus crime in their area among others.”
Similarly, in a survey last year from KFF, a nonprofit health policy research group, nearly six in 10 insured Americans said they had encountered at least one problem using their coverage in the past year. Yet in that same survey, a vast majority, 81 percent, gave their health insurance an overall rating of “excellent” or “good.”
Americans who rated their health as “fair” or “poor” were more likely to rate their health insurance negatively, as were those who were insured under the open marketplace through the Affordable Care Act. Even so, majorities of Americans in fair or poor health still rated their insurance positively, regardless of the type of insurance they carried. (About 8 percent of Americans were uninsured at the beginning of this year.)
But polling confirms there is no shortage of frustrations around health insurance and health care in general, with costs the most frequently cited concern. In a separate poll KFF conducted in February about health care affordability, nearly three-quarters of Americans said they were very or somewhat worried about being able to afford unexpected medical bills or the cost of medical services. These concerns were cited by more Americans than any other cost asked about, including expenses like food, gas and electricity.
Liz Hamel, director of public opinion and survey research at KFF, said that, in this way, Americans’ concerns about health care were somewhat wrapped up in their concerns about the economy as an election issue.
“The data show that health care costs are a big part of people’s concerns about the economy,” she said. “Also, when we asked people what they wanted candidates to talk about when it came to health care, it was cutting costs.”
In polling conducted last month by Gallup, Americans’ satisfaction with the cost of health care was low, and this was consistent across political affiliations. Just 15 percent of Republicans and 19 percent of Democrats said they were satisfied with the total cost of health care in the United States.
A partisan split does emerge, however, when Americans are asked if they would prefer a government-run health care system, or one based mostly on private insurers. Seventy-one percent of Democrats preferred a government-run system, compared with just 21 percent of Republicans. Overall, the nation is split on which system they’d prefer, with 49 percent of Americans saying they favor private insurance and 46 percent saying they would prefer a government-run system. However, support for government-run health insurance has been growing in recent years, as support for private insurance has waned. And with the margin of error, the support for either system is essentially tied.
https://www.nytimes.com/2024/12/13/us/elections/health-insurance-polls.html
Opinion: A call to abolish health insurance claim denials
by Greg Bates - Portland Press Herald - December 14, 2024
The power of health insurers to deny care must be abolished. In the case of for-profit insurers, it constitutes a conflict of interest that can inflict huge financial debt on patients and sometimes carries deadly consequences. America’s largest health care insurer reveals the conflict in sharp relief. UnitedHealthcare is five times the size of its nearest competitor. Under the recently assassinated CEO Brian Thompson, its claim-denial rate hit 32%, twice the industry average. The company covers 50 million Americans, with over 120,000 in Maine, making this our problem. Every Mainer has either faced fear of health care insurance denial or knows someone who has.
None of these facts justify Thompson’s murder. He paid the ultimate price – as have too many of his patients. Other insurance CEOs have removed their online profiles, fearing retribution. If we are going to seize this moment for change, we owe it to everyone to succeed.
Because corporations have a fiduciary duty to make profits for their shareholders, the conflict of interest cannot be corrected by imploring insurers (or raging at them) to act in the patients’ best interests. With health care insurers, investors come before patients. Pleas to reverse these priorities, even if temporarily successful, will hit the brick of this structural reality.
Nonprofit health care insurers have fewer incentives to deny care, but they can still abuse that power. No patient should face denial if a doctor has approved a treatment. And especially not after it has been administered.
But today, doctors can offer no such assurance. Any prescribed treatment can lead to hours of both patient and doctor battling insurers to secure needed care. All too often, they fail.
Insurers must treat patients as customers. It’s our money; we have the right to know what treatment will cost us, if anything, before we buy. Achieving that simplicity will take time. Ending insurers’ right to deny is an important step forward.
Banning claim denials would leave insurers with one recourse: take the provider to court. But the onus would be on insurers to convince a judge or jury that it should not cover a treatment. Court-mandated denials would carry the independent stamp of approval from the justice system.
However, restricting insurers’ ability to deny could worsen a health care-provider conflict of interest. Our fee-for-service system, where the more providers treat the more they get paid, creates a built-in incentive to bill for unnecessary care.
One solution is capitation payments, where providers are paid lump sums to look after a group of patients, reducing incentives to overtreat. Another tool is medical review boards to assess provider practices. Adjustments are made for the future without saddling patients with surprise bills after treatment. There is precedent for these: review boards already exist in some states to monitor excessive opioid prescriptions.
But if raging against health care insurers won’t provide lasting relief, how do we eliminate insurers’ power of denial? Social movements – including marriage equality and overturning Roe v. Wade – provide lessons, regardless of whether their victories align with our politics. In the case of marriage equality, the idea kept being reintroduced over years until public approval shifted. The tide turned and President Barack Obama switched his position. Initially, during his 2008 campaign, he opposed gay marriage. In 2010, he acknowledged that “attitudes evolve, including mine.” By May of 2012, likely recognizing the LGBTQ community’s large constituency, he switched. Backing same-sex marriage helped him win reelection.
Anti-abortion activists also spent decades, in their case, chipping away at Roe by pushing state restrictions and legislation banning so-called partial birth abortion instead of focusing solely on overturning the decision. They helped set the stage for President Donald Trump’s election and his appointment of Supreme Court justices instrumental to Roe’s defeat.
The lessons are clear: patient persistence can change the world. Any campaign to abolish insurers’ power to deny care must transcend the heat of this moment to forge a lasting movement.
https://www.pressherald.com/2024/12/14/opinion-a-call-to-abolish-health-insurance-claim-denials/
Deny and delay: The practices fueling anger at U.S. health insurers
National data is hard to come by, but doctors say treatment increasingly is being delayed by demands for pre-authorization — or denied outright.
by Peter Whoriskey - Washington Post - December December 16, 2024After a UnitedHealthcare executive was gunned down on a New York City sidewalk, an eruption of bitter online commentary celebrated the killer’s presumed motive: avenging the denial and delay of health insurance coverage.
Many spoke from personal experience. Every year, health insurance companies deny tens of millions of patient claims for medical expense reimbursements, and the tide of those denials has been rising, according to surveys of doctors and other health-care providers. Insurers also have been increasingly demanding that doctors obtain approval before providing treatment, similar surveys show, causing delays in patient care that the American Medical Association says are “devastating.”
While several states have passed legislation trying to restrict such practices amid growing public anger, insurers defend the coverage denials and “pre-authorization” requirements. They say those measures are meant to contain rising costs and that their methods comply with federal and state regulations. According to information the insurers report to regulators, there have been only small increases nationally in the frequency of denials in recent years.
Most frustrating, according to patient advocates, is that insurance companies often act without explanation, sending denial letters that offer only sparse justifications. The patient “gets a cryptic message saying ‘it’s not medically necessary,’ but without any other explanation,” said Elisabeth Benjamin, a vice president at the Community Service Society in New York, which runs a program that helps consumers appeal denials.
“People are mad because it’s all a big secret,” Benjamin said. “It’s unfair for us as a society, on something that’s so visceral, to trust giant corporations that make money when they deny care. This is why people are so, so very angry.”
Exactly why and how often claims are being denied or medical procedures are getting early scrutiny is difficult to know. Statistics regarding denials and pre-authorizations are scant, at best, and most of what is available reflects only one state or one type of insurance. Nationally over the last five years, the rates of denial have been between 14 percent and 16 percent, according to data from the National Association of Insurance Commissioners.
At least some state data, however, show big increases. In Maryland, for example, regulators report that the number of claims denied by the insurers they regulate has risen nearly 40 percent since 2019.
Pointing in the same direction are large majorities of doctors and other health-care providers who report that insurers are denying more claims and imposing more pre-authorization requirements. For example, a 2024 survey conducted by Experian Health indicated that 73 percent of health-care providers said that “claim denials are increasing.” An American Medical Association survey similarly found that almost three-quarters of physicians said that denials of pre-authorization requests for treatment have increased over the past five years.
“The most common feelings I see are frustration and a sense of powerlessness,” said William Bennett, an associate professor at the Indiana University School of Medicine who studies patient experiences and treats children with chronic illnesses. “Patients have a relationship with their doctor. Their doctors know them, their doctors are experts in their disease, and then, for some reason that is never explained, the recommended care is denied.”
Insurance industry representatives blame doctors for many of the denials, saying they botch the required paperwork by submitting inaccurate, incomplete or ineligible claims information. In a statement last week, UnitedHealth said that the company’s insurance division pays about 90 percent of medical claims when they’re submitted. Of the remainder that undergo additional review, only 0.5 percent are “due to medical or clinical reasons,” UnitedHealth said.
AHIP, a national association of health insurers, also issued a statement regarding denials, saying that “health plans are working to protect patients from the full impact of rising costs while connecting them to care that is safe, evidence-based and coordinated.”
Health-care providers have decried the requirements for prior authorization, which oblige doctors to request the insurer’s approval before providing patients with certain medical procedures and drugs. According to an AMA survey, nearly a quarter of physicians reported that these requirements led to an adverse event for a patient and more than nine in 10 physicians said the practice causes treatment delays. More than a quarter said their prior-authorization requests were often or always denied.
In response to such concerns, state legislatures have passed a raft of legislation. In 2024 alone, ten states have passed legislation aiming to cut what the AMA says is the “growing volume” of such requirements, to shorten the delays they cause, or to increase public reporting of data and procedures.
Only a small minority of patients appeal health coverage decisions, according to state and federal statistics. Many are daunted by the complexity of the medical terminology and the insurance bureaucracy.
“It’s hard to fight a big insurance company,” said Larry Levitt, executive vice president of KFF, a nonprofit health policy research and polling organization. “To even begin, you need to understand the gobbledygook in the paperwork. It’s hard to make heads or tails of it.”
In the Affordable Care Act, Congress authorized the establishment of Consumer Assistance Programs in the states to help people appeal denials of insurance coverage, but it has provided no funding for them in recent years. Even so, many states have set up offices to help.
Recent cases tackled by the Maryland attorney general testify to the range of arguments patients can have with their insurers. One patient experienced 30 percent visual impairment from eyelid inflammation and loose skin, but the insurer deemed the recommended surgery “cosmetic” and refused to pay. A 12-year-old received daily injections for a growth hormone deficiency for three years but, in the fourth year, the insurer deemed the shots not medically necessary and refused to pay. A patient having surgery to repair a broken clavicle unexpectedly needed work to repair a torn vein, but the insurer refused to pay for the extra procedure.
These denials would have forced each of those patients to pay thousands of dollars more than expected for needed care. After Maryland officials intervened, each of those consumers prevailed.
Last year, consumers in Maryland filed 11,466 challenges to denials. When a denial is challenged, consumers prevail about half the time, according to statistics from the state’s attorney general’s office.
But in Maryland, as in other states with programs to aid patients, officials say few consumers know that they can appeal a coverage denial, let alone that there is a program that can help them do so.
“We would love for more people to take advantage of this program,” said Marie Grant, Maryland’s acting insurance commissioner. “Insurance is inherently complicated and I deeply understand the frustration here. But people don’t have to be alone in this journey.”
https://www.washingtonpost.com/business/2024/12/16/deny-delay-health-insurance-anger/
Letter: We need single-payer health insurance now
I was interested to read columnist Victoria Hugo-Vidal’s view of the recent murder of UnitedHealthcare executive Brian Thompson (Dec. 15). She does seem to be speaking for many people in the country who are fed up with insurance companies putting profit above health care.
In my view, this angry energy is misdirected. Our health care system has become a for-profit industry. In a for-profit industry, one should expect that companies will strive for maximum benefit for their executives and shareholders, rather than for maximum benefit for their customers.
Presidents from both parties, going back to Theodore Roosevelt, have proposed national health insurance as the optimal financial structure for our health care system. Instead, we have our current system because we elect representatives and senators who favor private insurance with its massive administrative cost and profit motive.
I wish we all would redirect our attention from the perfectly predictable behavior of for-profit companies to this structural problem in our health care system. We should all demand that our political representatives in Washington reject the private insurance lobby and take seriously the need for single-payer national health insurance.
Reviewing the compelling arguments supporting single-payer national health insurance is beyond the scope of this letter, but for those interested in learning more, I would suggest starting with policy papers of the American College of Physicians (see ACPonline.org) and Physicians for a National Health Program (see https://pnhp.org).
Robyn Goshorn, MD, FACP
Portland
https://www.pressherald.com/2024/12/22/letter-we-need-single-payer-health-insurance-now/
Letter: Private health insurance is preying on America
I’ve long felt that universal public health care would help heal divisions in the U.S. by affirming a common commitment and destiny for all Americans. The murder of UnitedHealthcare CEO Brian Thompson, and the mass response to it, is the “negative” expression of this.
We all know — that is, know together, as a public — that private insurance is preying on us. We can build bridges between constituencies over this.
Kenneth James
Cushing
https://www.pressherald.com/2024/12/22/letter-private-insurance-is-preying-on-us/
How one doctor tried to take the profit motive out of health insurance
Let’s learn from the Affordable Care Act’s failed experiment with nonprofit insurance.
by - Lena Wen - Washington Post - December 24, 2024
Critics of the U.S. health-care system, attempting to capitalize on the fury Americans have expressed toward insurance companies since the targeted killing this month of UnitedHealthcare CEO Brian Thompson, have renewed calls to rethink how the United States pays for care. Some, for example, have returned to the idea of single-payer health care, which would eliminate the need for private insurance.
Such a complete overhaul is not realistic for the foreseeable future. But one idea is worth revisiting: creating models that offer alternatives to for-profit insurers.
This is not a new idea. The original version of the 2010 Affordable Care Act contained a public option — a health plan run by the government — to compete with private insurers. Lobbyists succeeded in getting the provision nixed, though Democrats managed to secure a last-minute compromise: a new nonprofit health insurance entity, called a Consumer Operated and Oriented Plan, or co-op.
Instead of reaping profits for shareholders, co-ops reinvest profits to offer more services and lower premiums. This can make them more attractive to consumers and put pressure on traditional insurers to improve their practices. Accountability is built in, as members elect their own board of directors.
Evergreen Health was one such co-op. The brainchild of Peter Beilenson, a physician and one of my predecessors as Baltimore’s health commissioner, Evergreen was intended to be a national model of patient-centered care. Beilenson hired clinicians, paid them a fixed salary regardless of how many patients they saw and opened four health centers where patients could have all their needs tended to in one visit. When they arrived, a health coach would counsel them on nutrition and mental health before a primary-care physician or nurse practitioner would treat them. If they needed further care, a specialist would come to the clinic to see them.
The idea was that such a “one-stop shop” prioritizing prevention would help patients stay healthier and avoid costly services down the line. Those cost savings would translate to revenue to enable more Evergreen clinics to open across Maryland.
Unfortunately, Beilenson’s grand vision never became reality. In 2017, five years after Evergreen started enrolling patients, it was forced to cease operations. And it’s not alone: Of the 23 co-ops that came out of the ACA, only three remain in operation. Combined, they serve just 140,000 patients.
Why did co-ops struggle so much? Start with money. The ACA was supposed to provide $10 billion in grants to help co-ops get off the ground in every state, but that was changed to $2.4 billion in loans with a tight repayment schedule.
Onerous rules were also a major hurdle. The co-ops were prohibited from using government funding for marketing, a challenge for start-ups with no name recognition. They also couldn’t enlist large businesses as customers, meaning they had to limit outreach to individual buyers and small-business owners.
“Since no one knew who we were, they didn’t sign up with us,” Beilenson said. He told me that in their first year, only 44 people enrolled.
Evergreen gained more members as he and his team pivoted to focus on small businesses. Word of mouth helped, too. “A lot of people signed up with us because they believed in the co-op model,” he said. He began to see positive results; for example, he told me, their diabetic patients were 21 percent less likely to be hospitalized than patients on traditional insurance.
But Evergreen couldn’t generate enough revenue to pay back the $65 million it owed in government loans. Plus, ACA regulations intended to stabilize the insurance market worked against the co-op. The law requires insurers with lower-risk enrollees to pay money to competitors with higher-risk ones, to ensure that they are competing with their plans, not their patients. Because Evergreen’s enrollees were deemed healthier than those of its main competitor, it was on the hook to pay CareFirst Blue Cross Blue Shield, a massive, well-established company, nearly 30 percent of its revenue.
“We were basically running around with one hand tied behind our back and another leg tied to the other leg,” Beilenson said. “There was just no chance of succeeding.”
So what now? Beilenson, though he has long supported a single-payer system, doesn’t believe abolishing insurance companies is realistic. But he is optimistic that there could be renewed energy to reengage around the public option — or to make another attempt at co-ops, though without all the obstacles that made them near-impossible to operate the first time around.
I, too, hope the groundswell of consumer fury will prompt lawmakers to reform the insurance industry. They should heed the lessons from the ACA co-ops and give innovators the tools to succeed rather than doom them to fail from the outset, leaving Americans with the same frustrating, unjust and unhealthy system
https://www.washingtonpost.com/opinions/2024/12/24/insurance-health-care-nonprofit-co-ops/
My Restaurant Was Named One of New York City’s Best. Here’s Why It Closed.
by Yannick Benjamin - December 28, 2024
Last Saturday, I poured wine, greeted regulars and strangers and bused tables at Contento, the restaurant I co-owned in East Harlem, for the last time. After more than three years of service, during which The New York Times ranked us twice among the 100 Best Restaurants in New York City and the Michelin Guide gave me its sommelier award, I had to say goodbye to my talented staff and lifelong dream of owning a restaurant. The combination of inflation, rising crime that required us to pay for security guards and declining profits simply proved insurmountable.
I’m crushed that we had to close Contento. I have to admit I’m also relieved. Running a restaurant in 2024 meant taking no salary while working a full-time hospitality job elsewhere in order to afford private health insurance. This is the cruel math of owning a small business and being disabled in America.
My story is one small part of an ongoing struggle for restaurant workers and culinary culture across New York City and the country. If you’re wondering why you so rarely see a disabled person like myself on a wheelchair on the floor of your favorite restaurant, why menu prices seem so high or why service feels uneven nearly five years after the pandemic began, the American health care system deserves much of the blame. If that sounds melodramatic, ask your favorite server.
It has always been difficult to sustain a career in hospitality, but brief rumblings of progress during the early days of the pandemic brought us some hope. In 2020, when the true value of essential workers and the inequities they faced finally pierced the public consciousness, it seemed like we were on the brink of major change.
A glittering cast of chefs from across the country banded together to create the Independent Restaurant Coalition, an organization that began to lobby for financial and legislative protections for restaurant workers. In May 2020, chefs, chain restaurant executives and other culinary professionals went to the White House to campaign for federal assistance for restaurants. I hoped that the silver lining of that horrific global crisis was an opportunity to create a more sustainable restaurant industry, with the kind of jobs that people can keep without worrying about the worst.
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Those positions largely still don’t exist. Restaurants have reopened their doors and reservations at top tables are as tough to get as ever, but make no mistake: The restaurant business is failing the people who love and need it.
According to the U.S. Bureau of Labor Statistics, only 40 percent of full-time hospitality workers have had access to health coverage in 2024, compared to the 87 percent of full-time private sector jobs that offer it. As a result, many of the 17 million Americans who work in restaurants and hospitality are most likely skipping annual checkups or pap smears or praying their cough goes away on its own. They can’t afford to take a sick day.
People who work in food preparation and service have some of the lowest wages in the country, whether they’re operating a frying basket at a fast-food chain or prepping haute cuisine at a fine dining institution. In an industry where 10 percent profit margins are a gold standard of success, most restaurants can’t afford to offer standardized pay or consistent hours — the former is one of surveyed employees’ top reasons for leaving restaurant jobs — let alone benefits that give our work force a chance to live with dignity.
If people have other options, why wouldn’t they leave for jobs that better support their physical and mental health? Or that allow them to stay home when sick or grieving or without child care?
The few restaurant jobs that provide benefits and more stable working conditions require compromises of their own. Corporations with 50 or more employees, such as Starbucks, are required to offer full-time employees health care benefits. They’re able to do so and remain profitable partially because their size gives them leverage to negotiate with financial institutions and health care providers.
It’s a complicated bargain for workers, though. If a chef at a larger restaurant receives a job offer that would jump-start her career, but it doesn’t include health care and she has a pre-existing condition or plans to start a family, she may have to turn it down. Her professional potential is dictated by what benefits she can afford to lose.
Meanwhile, the most talented baristas at Starbucks or dedicated corporate chefs at Marriott don’t usually win James Beard Awards or get included in best-of lists. For ambitious chefs and hospitality professionals, it becomes a trade-off: Either you can afford a root canal, or you can have a creatively fulfilling career.
I get why independent restaurant owners can’t afford to do the right thing by all their employees, especially those with long-term medical needs or disabilities. I’ve used a wheelchair since 2003, when I was paralyzed in a car accident, and cannot pay for it without private insurance. My chair costs about $13,000 out of pocket, some $6,000 of which later gets reimbursed by my provider. In a comically dark turn, my insurer doesn’t cover the wheels.
This is all a terrible way to treat people, and I feel it deeply from both sides of the equation — as an owner who couldn’t provide health coverage for our staff and as a worker who still has to struggle for it on my own.
I believe that the restaurant industry is a place of second chances. It’s where undocumented people can find work and where formerly incarcerated people who have paid their debts to society can often get hired. We’re failing them because the industry is failing everyone. And then there are people like myself who are passionately drawn to this work.
I learned about hospitality from the very best. My father was a French immigrant who became a career waiter in some of New York City’s top restaurants. His job supported my family, thanks largely to his membership in a union that worked with fine dining institutions of 20th-century Manhattan such as Le Cirque. In 2023, however, less than 1.5 percent of food service workers were unionized, according to the U.S. Bureau of Labor Statistics. It’s nearly impossible for an independent restaurant owner to afford to pay union subsidies and hire workers like my father amid unpredictable rent hikes, planned utility taxes and alarmingly high industrywide staff turnover rates.
As a result, our culinary culture suffers, too. Unlike tradition-bound corners of Italy or France, American restaurants are defined by their openness to new ideas. How can we cultivate innovation if we can’t properly hire, compensate or retain staff? Who knows how many clever menu concepts or hospitality innovations we’ve lost because people can’t afford to keep their restaurant jobs? Or because those on wheelchairs like mine quite literally can’t get in the door?
During our last six months at Contento, as we crunched numbers to try to keep the lights on, I had to make gut-wrenching decisions. When reservations were sparse, we had to let people go. Against my values as a business owner, we would tell the second bartender to clock out early or rely on one dishwasher instead of two. This affects how people live. My staff aren’t nameless, faceless statistics. They’re people I hired, mentored, valued and admired. I’d met their roommates and their children. They supported me and mourned with me when my dad died earlier this year.
It’s been nearly five years since the pandemic upended every facet of people’s lives, but there’s still time for restaurant industry power players to harness the momentum of those early months. They could use their influence to lobby for subsidies like the tens of billions of dollars that airline executives secured as part of the CARES Act in 2020, and use that cash injection to create a health care model for restaurant workers. With enough pressure, the federal government could distribute a national version of the $3 million fund that New York City provided to some 100 independent restaurants in 2020. A healthier, more stable work force would make the entire industry more sustainable.
The best restaurant workers give their all to each night of service. They bend over backward to make sure guests have birthdays, anniversaries and evenings that are truly special.
Our hope for ourselves is less grandiose. We just want the dignity of ordinary days.
Yannick Benjamin is a New York City sommelier and activist. He is the co-founder of Wine on Wheels, an advocacy organization for people with disabilities.
https://www.nytimes.com/2024/12/28/opinion/resturant-workers-health-care-crisis.html
How ‘Health Freedom’ Became a Winning Rallying Cry
by Kate Morgan - NYT - December 28, 2024
Leah Wilson’s small organization was less than a year old when she realized she was making a difference. It was the beginning of 2020, just before the Covid shutdowns, and hundreds of protesters had gathered to demonstrate outside the State House in Trenton, N.J. They held signs with slogans like “my child, my choice” and “hands off our kids,” urging politicians to vote against a bill that would end religious exemptions for school-mandated vaccines.
Ms. Wilson, 38, wasn’t there. She was almost 700 miles away in her home state of Indiana. But more than 80,000 people had used her online platform to send messages directly to legislators. The measure ultimately fell short of passage by a single vote.
It was an outcome “no one thought was possible,” Ms. Wilson said, but her side had won.
Ms. Wilson’s organization, Stand for Health Freedom, has become part of a grassroots push in the years since. Hers is just one of many groups dedicated to the cause of “medical freedom,” a catchall term for ideas that often diametrically oppose scientific consensus and established medical practices. The movement has brought in people of various political persuasions, and Ms. Wilson considers her own organization “transpartisan,” though most of the candidates it endorses are Republican. To Ms. Wilson, those involved have coalesced around one idea: “There’s roles for government, and telling us how to care for our bodies is not one of them.”
The medical freedom movement represents people with a broad range of positions. Many want to reduce Food and Drug Administration oversight and see the United States exit the World Health Organization. They’re often resistant to proven public health measures like mask mandates and water fluoridation, and they support access to raw milk, despite the health risks associated with it. (On the issue of abortion, Ms. Wilson is anti-abortion but said she preferred that her group avoid the “very charged political issue.”)
Perhaps more than anything else, “medical freedom” has come to serve as a rallying cry for people who not only oppose vaccine mandates, but also see them as un-American. Ms. Wilson said she and her organization strove to be “protectors of freedom.” Her advocacy, she said, is ultimately about asking one question: “Do we truly believe that the American experiment of freedom is a worthy one? I do.”
Since the pandemic, the movement has gained momentum. Anti-establishment sentiment erupted as a result of Covid-related shutdowns and edicts. Medical freedom groups in places like Texas and Mississippi gained influence and secured victories, including around the issue of religious exemptions to vaccine mandates. The groundswell of interest energized Ms. Wilson’s small group as well. Though it has just two full-time employees and an annual budget around $400,000, the organization has used the internet to exercise outsize influence. It has issued 520 calls to action, according to the organization’s latest report, and had 72 “legislative wins” in which the vote went its way. More than 700,000 people have sent close to six million missives to legislators through the platform.
The energy has led to concern and anger among many medical professionals. Dr. Paul A. Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, sees the growing medical freedom movement as a pressing threat to public health — one that selfishly disregards the lives of others.
“It’s not just your body. Is it your right to catch and transmit contagious illnesses?” Dr. Offit said. “I think the answer to that question is, resoundingly, no. You’re a member of society. Act like one.”
Government Denial Leads to Action
Ms. Wilson felt a pull to get involved in activism in 2018, soon after she and her husband decided they were ready to take in a second foster child.
Ms. Wilson had long been passionate about the care of foster children. At 21, she became a court-appointed special advocate for them, and enrolled in law school with initial ambitions to work in child welfare.
The Wilsons decided not to vaccinate their biological children, which was not an issue the first time the couple fostered a child; they had filed for a religious exemption, which the state accepted. (When asked what beliefs she held, Ms. Wilson said it was irrelevant, adding, “there are so many different reasons why the practice of vaccination, or many other medical interventions, could violate a person’s deeply held personal beliefs.”)
But the second time, in 2018, the Indiana Department of Child Services told Ms. Wilson that the religious exemption no longer applied and that children wouldn’t be placed in households with unvaccinated family members, Ms. Wilson said.
For Ms. Wilson, the news was jarring, and evidence of government overreach. “My husband and I were like, ‘This is crazy. Our kids aren’t sick; they’re not a threat. This is nonsense,’” she said. Around then, a number of states introduced bills to remove religious exemptions from school immunization requirements after measles outbreaks. Both Maine and New York voted to remove their exemptions in 2019. New Jersey’s bill had passed the State Assembly and seemed poised for passage in a January 2020 Senate vote.
It felt as if other parents were facing situations similar to hers, and Ms. Wilson wanted to “give the people a voice.” She decided on a specific strategy: providing predrafted emails that could be personalized and sent directly to legislators through a website.
Part of a Broader Movement
Stand for Health Freedom is a young organization, but the wider movement “goes to the very roots of America,” said Lewis A. Grossman, a professor at American University’s law school who has studied the history of libertarianism.
“There’s always been a robust portion of Americans who embrace these values,” Mr. Grossman said. As early as 1902, organizations like the American Medical Liberty League were pushing for freedom from vaccine mandates. In the 1950s, the John Birch Society and National Health Federation took up the cause. In 1975, a group opposed to water fluoridation in Rockland Country, N.Y., called itself the Citizens for Health Freedom.
But by and large, these groups and others like them existed outside the mainstream. Starting in the 1960s, however, American trust in institutions began to wane. And as vaccines successfully eliminated polio and measles — and greatly reduced rates of whooping cough and other infections — the perceived benefits of immunization began to fade from some people’s minds as well.
“It’s not only that we’ve largely eliminated measles from the United States,” Dr. Offit said. “We’ve eliminated the memory of measles.”
Then, Covid struck and cities were locked down. Public health officials also fumbled critical early messaging, painting the vaccine as a “miracle” that would provide immunity with a single dose, said Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“We really lost credibility, because that’s not what happened,” Dr. Osterholm said.
Suddenly, medical freedom became a salient issue to many more Americans, and resistance to Covid restrictions became their unifying principle. Melanie Dragone, 48, who lives in Passaic County, N.J., and runs a group that opposes vaccine requirements, said the pandemic “grew our community exponentially.”
Much of that growth occurred online, as people lost faith in traditional medical institutions and searched for like-minded thinkers, Dr. Osterholm said. New supporters flocked to Ms. Wilson’s organization as it took on all sorts of causes. It opposed the construction of new Verizon cell towers in rural Nevada, citing “potential” radiation damage. (Gayle E. Woloschak, an associate dean and professor of radiology at the Northwestern University Feinberg School of Medicine, has said there is “no risk.”) It supported the proposed federal PRIME Act, which would allow some local livestock producers to sell meat that was not inspected by the United States Department of Agriculture. (Ms. Wilson’s organization said the bill would “protect our meat from Big Pharma”; a food safety coalition said the measure would “compromise long-established food safety standards.”)
But like the activities of many organizations in the medical freedom movement, much of Stand for Health Freedom’s advocacy came to revolve around removing or blocking vaccine-related restrictions. Among the platform’s targets were a pending Georgia bill that would prevent hospitals from denying organ transplants to the unvaccinated and a Kentucky law, enacted last April, that requires any produce or other food item engineered to contain “vaccine material” to be labeled a drug. (There are currently no such products on the market, though scientists are experimenting with vaccine-laden lettuce and spinach in an ongoing study at the University of California, Riverside.)
As it grew, Ms Wilson’s organization gained support from a politically diverse group of advocates. Roughly 40 percent of the people who have taken action on the platform are Democrats, she claimed. Ms. Wilson saw this as evidence that “there are plenty of people who care about being the one who makes the ultimate health decisions for their children,” she said.
“This is common sense,” she added, “not strange or rare.”
A New Position of Power
In September 2023, only a few years after forming her organization, Ms. Wilson flew to Los Angeles to interview the leader of her movement: Robert F. Kennedy Jr.
For decades, Mr. Kennedy has promoted fringe ideas, most famously the thoroughly debunked idea that vaccines and autism may be linked. But over the pandemic, Mr. Kennedy’s longtime areas of focus became some of the country’s most passionate points of contention. In May 2023, when Gov. Ron DeSantis signed a bill barring vaccine and mask mandates in Florida, he boasted that it made the state “the national leader for medical freedom.”
By the time Ms. Wilson appeared onstage with Mr. Kennedy, he had become a folk hero to some by loudly expressing skepticism of Covid decrees. One month earlier, he had announced his candidacy for president. Still, even Mr. Kennedy was surprised, he told Ms. Wilson, when polling numbers showed sizable support for his presidential bid.
“I had nothing but bad articles written about me for years,” he said onstage. “I assumed that the general population of our country would have a very low opinion of me.”
Instead, he built a passionate coalition. It included Ms. Dragone, who had previously been a lifelong Democrat. She said that her dedication to health freedom now outweighed her other political leanings. So when Mr. Kennedy suspended his own campaign and endorsed Donald J. Trump, Ms. Dragone decided she would cast her ballot for the former president.
“I don’t think I would have voted for Trump otherwise,” she said. “Actually, there’s no way.”
Mr. Trump has since selected Mr. Kennedy to run the Department of Health and Human Services and has met with medical freedom activists in New Jersey. In November, Mr. Kennedy said that he did not plan to “take away anybody’s vaccines.” But, he added, he wanted to make sure that people had the freedom to choose whether to take them at all. After decades of being on the fringes, and perhaps for the first time, “medical freedom activists are in a position of power, rather than resistance,” Mr. Grossman said.
Dr. Offit said the United States was already experiencing “the effects of medical freedom.” In recent years, opposition to vaccine requirements for students and children has risen, and vaccination rates for kindergartners have fallen, according to the Centers for Disease Control and Prevention.
That trend leaves the nation poised to lose herd immunity to childhood diseases, Dr. Offit said, if it hasn’t already. Rates of whooping cough are climbing. A strain of the polio virus is still present in the environment, and could begin to infect more people. Measles outbreaks have occurred in dozens of states, and Dr. Offit worries it will only get worse from here.
Whether these developments might turn the tide away from medical freedom remains to be seen.
“How many children have to die to get their attention? I don’t know,” Dr. Offit said. “I guess we’ll find out.”
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