Healthcare and Folk Heroes

And A Trip to the Countryside

Woody is on the trail of something wild, on the dirt roads of Arjac, France.=

Carolyn and I had a great weekend visiting Peter, an old friend of Carolyn’s from her days as a student in Paris. Peter lives in a small town called Arjac, west and south of Montpellier. He shares the beautiful farmhouse and renovated barn with his partner Simon and two dogs. It’s a two-and-a-half-ish hour train ride to get to Montebaun (outside of Toulouse), and then about an hour in the car to Peter’s country house; the car transport is always cheerfully provided by Peter.

Dog Taxi

This trip was bittersweet, with all the dogs around, we were missing sweet Rudy. Woody enjoyed hanging out with other pups, walking country roads and fields, smelling deer, cows, wild pigs, and mulch. There was a big fenced yard for him to run around off-leash. Even though it was rainy, he loved it! So did we. A cold, rainy weekend in the country is a good excuse to stay inside, eat great food, drink too many cocktails, watch movies, and tell old stories. There might have been some excessive doggie pampering/cuddling too.

We were transfixed all weekend by the manhunt for the gunman who killed Brian Thompson, the UnitedHealthcare executive, in New York five days ago. Part of the reason this story has captured the notoriously short American attention span is that we are in the open enrollment period for insurance under the Affordable Care Act (a.k.a. Obamacare). In the middle of the manhunt, shopping for insurance is reminding us how much we pay for health insurance, how little we get for our money, how much profit the insurance companies make, and how disgustingly lavish the healthcare executives’ compensation packages are.

The shooter has become something of a folk hero in the vein of Charles Arthur “Pretty Boy” Floyd, the depression era bank robber who was immortalized in a ballad by Woody Guthrie. (My favorite version of the ballad is actually performed by Ramblin’ Jack Elliott - you can hear it on his album Kerouac’s Last Dream.)

For those of you unfamiliar with Pretty Boy Floyd, the (disputed) story is that he destroyed mortgage documents during bank robberies, preventing banks from foreclosing on farms. In the ballad he also gives food and money to poor farmers so they can have a Christmas feast or pay off their mortgages. Pretty Boy Floyd was eventually killed by FBI agents—this was the J. Edgar Hoover era.

Assuming the killer of Mr. Thompson is captured alive, I can’t help but wonder if a jury would convict him. I would never advocate violence or vigilante-ism, but I grew up in a house where the adults admired and wanted to be like the cop/cowboy vigilantes played by Clint Eastwood and Charles Bronson; I understand the mental and social chemistry that makes so many Americans root for a guy like the killer in New York.

Mr. Thompson was paid over $10M last year as Chief Executive of UnitedHealthcare, his pay was a mix of a $1M “base” salary plus stock and cash grants. His compensation wasn’t even exceptional; the head of Cigna was paid $79M, Humana $21M, Anthem $19M, Aetna $17M. The list goes on.

Under Thompson’s leadership, UnitedHealthcare’s profits grew from $12B to $16B in three years. Think about that number for a moment: sixteen billion dollars! It’s not gross revenue, it’s not gross margin. Profit is the money UnitedHealthcare kept after all costs, including Mr. Thompson’s whopping paycheck. The average family of four pays about $17,000/year in premiums. To reach $16B in profits, UH would have to retain every penny of the premiums paid by 940,000 families (those are families of four, so premiums for 3.76 million people)! That’s money that UnitedHealthcare is pulling out of the healthcare ecosystem to line their pockets, boost their stock price, and reward shareholders. That money is not being used to provide care. Sixteen billion dollars. One health insurance company. Industry-wide profits in 2022 were over $40B (or all of the premiums paid by 2.36 million families/9.44 million people)! It’s sickening, no pun intended.

This graph shows profit growth of United Health Group Inc. (stock symbol UNH) and includes profits from both their insurance division (UnitedHealthcare) and their healthcare services division (Optum)

Carolyn and I are in the middle of investigating how our health insurance and tax situations would change if we were to get our Carte(s) Vitale and go onto the French system. We did some consulting with a tax lawyer earlier this year who was able to explain how various types of income are taxed and how the tax treaties between the US and France work. We still need more information, especially about how joining the French scheme would affect our future Social Security and Medicare coverage.

Here’s a recent experience of mine that illustrates the difference between a hybrid system (the French system, it isn’t single payer) and the for-profit system in the US:

I had a mild case of food poisoning a few weeks ago that wouldn’t clear up. After a week, I went on-line and managed to get a doctor’s appointment the same day. I was seen on time, the doctor spoke English, and talked to me for 15 minutes (I threw in some French where I could!). He gave me a prescription for two labs (blood and stool analysis) and prescribed three medications: stronger versions of immodium and paracetamol, plus an antibiotic. Then he apologized for having to charge me €18; at the lab I received another apology as I was charged €20 for the blood and stool analyses, and finally walked to the pharmacy where the three prescriptions (and another apology) cost €17 for a grand total of €55 (at today’s exchange rate that’s about $58 USD). These are the costs with NO INSURANCE.

The French Carte Vital which gives one access to the national healthcare system.

My current US health insurance is through Oscar. If I had received treatment for the same food poisoning in the US, my co-pay would have been $50, plus a share of the prescriptions, and probably some out-of-pocket costs for the labs since I’m nowhere near our $1,500 deductible or $11,000 annual max out of pocket. That’s on top of the $30K a year we are paying in monthly premiums (these are the family numbers for our joint coverage). Of course, this assumes I could get an appointment with a provider in an appropriate timeframe. I had to wait two weeks last time I needed an appointment in Austin. Anyone who has had food poisoning will tell you that two weeks is not a useful timeline for care. That means I would have probably gone to the ER.

At the Emergency Room, I’d have been responsible for 100% of the cost up to my deductible ($750) and 30% of everything after the deductible. I went to Claude, my AI tool of choice, and asked what a trip to the ER would cost including the office visit, stool analysis, and blood work. Here’s what I got:

Yes, the French are taxed a lot and it’s not a perfect system. (At the end of the day I don’t think they pay much more than the average US citizen when you count our sales tax, income tax, property tax, and healthcare premiums/copays/coinsurance). French families aren’t being bankrupted by medical debt or having their life savings wiped out by a for-profit healthcare system. There will be over 325,000 bankruptcies due to medical debt in the US this year. Additionally there will be 267,000 bankruptcies that list significant medical debt as a factor. Finally, about 11% of students will drop out of college due to health issues, with medical debt being a major factor. There are 18 million graduate and undergraduate students in the US, so that’s another 2 million people who will have their dreams and professional lives shattered by our healthcare scheme. And it will all repeat again next year. And UnitedHealthcare will undoubtedly increase their profits, maybe they’ll hit $18 billion.

The last stanza of Woody Guthrie’s Pretty Boy Floyd goes like this:

As through this world I’ve wandered, I’ve seen lots of funny men

Some will rob you with a six gun, and some with a fountain pen.

As through this world you ramble, as through the world you roam

You will never see an outlaw, drive a family from their home.

Jusqu’à la prochaine fois.

Roberto & Carolyn

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