UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

Drug pricing, R&D, and marketing

• Debate over who really funds new therapies: several say “big pharma” bears most R&D cost, others stress that governments/universities do much of the basic science and early discovery.
• Academic PI in thread: basic research and target discovery largely in academia (often gov- or pharma-funded); clinical trials and iterative development are mostly industry and “incredibly expensive.”
• Disagreement on marketing vs R&D spend: some claim marketing is ~10× R&D; others show examples (Merck, AbbVie) where SG&A is roughly 1–2× R&D and includes non‑marketing overhead.
• Old generics (insulin, albuterol, etc.) cited as evidence of price gouging in the US vs much cheaper prices abroad.

Insurers, incentives, and denial of care

• Many argue US insurers benefit from high medical costs due to the ACA “80–85% medical loss ratio”: if allowed profit is a percentage, bigger total spend → bigger absolute profit.
• Insurers accused of routine denials (one figure cited: ~32% denial rate at UHC), algorithmic decision-making, and perverse deals via pharmacy benefit managers (PBMs), including forcing brand-name drugs over generics.
• Others note hospitals and pharma also exploit the system, with inflated “chargemaster” prices and hidden rebates; each sector blames the others.
• Some push for strong regulation or outright non‑profit/nationalized insurance; others fear “more government” would worsen things.

CEO shooting, public reaction, and jury nullification

• Thread frequently references the recent assassination of a UnitedHealth executive, speculating motive may be claim denials (based on “delay/deny/defend”‑style inscriptions on shell casings). This is labeled a leading theory but not proven.
• Online reaction is described as unusually unified in lack of sympathy for the CEO, framed as backlash against an insurance system seen as killing people by denying care.
• Big argument over whether a jury would convict:
  • One side emphasizes open‑and‑shut premeditated murder and standard evidentiary rules; expects conviction, possibly after retrial if there’s a hung jury.
  • Others stress the possibility of jury nullification, citing historical examples and growing public anger; some think at least one holdout juror is plausible.
• There is sharp moral disagreement:
  • Some commenters say celebrating the killing is “ghoulish,” insist murder is always wrong, and warn against normalizing political assassination.
  • Others frame the CEO as a “mass murderer” via denied care, argue that when legal and political systems fail, violence becomes “logical” to some, and see the killing as deterrent or retribution.
  • A minority explicitly condemn both the system and the murder, warning that endorsing this is support for domestic terrorism.

Public vs. private systems and international comparisons

• Many non‑US and some US commenters call themselves “lucky” to have public or mixed systems; view US private insurance as offering “pay more for less” plus leaving many uninsured.
• Examples given:
  • Brazil described as having constitutional, free universal care, with private insurance competing by offering faster access and broader coverage; claims that people don’t go bankrupt over health there.
  • Others counter that not all advanced/experimental regimens (like dual biologics at very high doses) would be approved or supplied in such systems, citing UK/ NHS documents and Brazilian formularies.
• Ongoing dispute whether single‑payer would prevent extremely expensive, cutting‑edge regimens from existing, or would simply ration differently and more transparently.

Price opacity and billing games

• Numerous anecdotes of absurd US bills (ER, chemo, imaging, surgery, lab work) followed by huge “discounts” after negotiation or insurer adjudication, likened to fake “Black Friday” markdowns.
• Patients report:
  • Hospitals refusing to provide firm pre‑procedure prices, or giving lowball “estimates” followed by much higher actual bills.
  • Separate surprise bills from subcontractors (anesthesia, labs, radiology).
  • Itemized statements with meaningless codes and resistance to explaining or correcting errors; frequent collections threats.
• People note federal hospital price‑posting rules exist, but data are buried in massive, unintelligible spreadsheets and don’t reflect insurer negotiations.

Rationing, experimental treatment, and cost control

• Core concrete case: a severely ill ulcerative colitis patient whose life is stabilized only by an off‑label, dual‑biologic, very high‑dose regimen. Insurer initially covers; later tries to stop paying, pushing cheaper standard options that had failed.
• Disagreement over whether insurers are “the bad guys”:
  • One camp says they knowingly cut off the only working therapy to protect profits, despite overall profits in the billions and executive pay in the tens of millions.
  • Another camp argues some actor must say “no” to multimillion‑dollar, weak‑evidence regimens or costs will explode; they stress that dual biologics at extreme doses are under‑studied and not widely approved outside the US.
• Some maintain that in many other countries, once a condition is covered, insurers (or the public payer) cannot refuse any medically proven treatment solely due to cost; others respond that “medically proven” is the key constraint and that this particular combo likely would not qualify.
• Broad consensus that some rationing is inevitable; conflict is over who decides (private insurer vs public payer vs clinician) and on what criteria.

System-level critiques

• Many see US healthcare as a captured, oligopolistic market where insurers, hospitals, drug makers, and PBMs coordinate to maximize extraction from patients and employers.
• Employer‑tied insurance is blamed for locking workers into jobs and depressing labor mobility, with calls to abolish it and move to one unified system.
• Several suggest that elites and media care far more about one murdered CEO than about countless deaths from denied care, reinforcing perceptions that some lives “count more” than others.