The assassination of Brian Thompson, the CEO of United Health Care Inc., my health insurance company, was met with a decided lack of outrage at the killing. Now, what constructively can be done to make corporate health care a tool to improve individual and public health?

The corporate for profit model has perfected limiting and denying care in the pursuit of profit. United Heath Care was among the largest companies and the most successful in denying claims and increasing profits.

I will outline a new model in which private insurance companies make more money by improving the health of their customers, and make less if the health of the community declines. Fundamentally, the goal of health insurance must be to improve public health and prevent disease and be rewarded by increased profit by helping build a healthier population.

The failing U.S. health system

The U.S. system is both by far the most expensive, with many millions without health care, and dismal public health performance.

My wife, a psychiatric clinician, has many tales of fighting with guilty insurance companies who do not want to pay for patient care. And then there are the insurance staff who report that their Christmas bonus is based on the more they disqualify.

Sept. 2024 data found the U.S. spends almost twice as much as similarly rich countries. The U.S. spent $4.5 trillion on health care, which is $13,439/person. The U.S. has 27.1 million uninsured, around 9.6% due to Obama Care, which Trump pledges to destroy, which decreased uninsured from 17%.

In the U.S. you are less likely to see a doctor, have longer hospital stays, have a harder time making a prompt appointment for medical care as the U.S. has fewer doctors per capita.

Certainly the U.S. should be able to cut the health care budget by a $ trillion dollars a year, or more, and at the same time improve public health. The existing system is not competitive, designed to maximize profit by most participants including drug companies, a forest of duplicate insurance companies, battalions of middle men, for profit hospitals, medical coding and billing as dark art to increase medical and hospital changes.

And last, but not least, Medicare Advantage plans that skim billions from Medicare by denying benefits for the old and sick. The hook is offering low cost, even zero monthly premiums, which was what I signed up for, plus additional benefits like dental care, eye glasses, hearing aids, all of which Medicare cannot offer. Looks good until when you are really sick and coverage is denied on the basis of an AI model. United Heath Care a leading offender as both claim denial and profits soared. Bring out your dead!

A pubic health based health insurance system

“First do no harm” (Primum non nocere) is a phrase coined by Hippocrates. In the Epidemics, Book One Hippocrates declares "Practice two things in your dealings with disease: either help or do not harm the patient".

This must be the inseparable foundation of health insurance. Clearly, current bad health and high profit is a complete violation of the Hippocratic Oath in the name of greed.The current incentives are simply immoral and lead to disastrous consequences for both patients and society..

Private profit must be the result of individual patient and collective public health benefit. This is the moral and collective basis for health insurance profit. A Brian Thompson in this world would be celebrated and praised by the community as a healer who saves lives and supports families both poor and rich.

I am not declaring a war on profit, but on negative consequences. Once upon a time I was an energy broker buying natural gas for Stoneyfield Farm, SNHU and others. I dealt with people in Houston selling natural gas. We made verbal deals over the telephone for millions of therms of natural gas, at a set price for an agreed upon term up to five years sent from Henry Hub in Louisiana to the NY Merc. Every hand shake deal worked. It was explained to me that the system of quickly buying and selling would collapse if people could not be trusted to cover their commitments.

The gas men of Houston were far more trustworthy than many (but not all) of the solar developers I have been working with for whom handshake deals meant next to nothing. The gas business had clear standards and rules that all players knew. In the new solar business this was not yet the case that made it much easier to cheat or dispute.

An ethical for profit health insurance system must be based on clarity and fairness following rules that work and result in making more money on the basis of success. In this case the improvement of individual and public health

Dynamics of public health based for profit system

The most straightforward way to have a driven-for-profit public health insurance system based on improving public health and personal health is for the private companies to partner with State and City public health agencies as well as academic public health groups like Harvard School of Public Health and its partner teaching hospitals.

This is a four phase partnership between

A. State & City public health agencies
B. Academic Public Health Agencies and Teaching Hospitals
C. U.S. Health and Human Services Offices and Agencies (10 agencies like CDC, FDA and 3 Human service agencies)
D. Private For Profit Insurance on a state level

All four groups will cooperate to evaluate existing public health challenges and develop comprehensive plans to understand existing health conditions and challenges and the economic, social, and health dynamics.

State by state plans are to be implemented by all four groups. Efforts and finance on a government, state and community level will be focused on both a public health and personal improvement level. Essentially, the private health companies will have a public health determined budget to meet health goals. If the insurance company’s actions exceed health goals they would make more money from increasing health, and similarly they would make less money if health did not improve.

Private health insurance companies bid for four year state contracts based on best proposals that may or may not be low bidder and have the right to keep the contract for further four years if public health increases, or other competitors may be able to make competitive bids if health has not met health improvement plans. Government owned or non-profit insurance companies should also be allowed to bid for health insurance business.

Conclusion

U.S. health care could benefit greatly by a public health orientation to improve health thus making better health the primary monetary incentive instead of making profit the goal at the expense of health. At its best such a system would be creative, effective and encourage entrepreneurial renewal. On a state by state level, a number of different and creative plans can flower.